<div>
	<table cellpadding="5" cellspacing="0">
	    <tr>
	        <td style="width: 130px;"><span class="label">{translate}Treatment doctor{/translate}</span></td>
	        <td style="width: 200px;">
	            <select id="doctorId" name="doctorId" style="width: 165px;">
	                <option value="0">- - {translate}Bac si{/translate} - -</option>
	                {html_options options=$doctorList selected=$radTicket->getTreatmentDoctorId()}
	            </select>
	        </td>
	        <td rowspan="2" valign="top" align="left">
	            <span id="radAssignmentMsg" class="formAlertMsg" style="padding-left: 5px;"></span>
	            <div id="createAssignmentLoaderDiv" style="display: none;">
	                <img src="{$base_uri}images/ajax-loader.gif">
	            </div>
	        </td>
	    </tr>
	    <tr valign="top">
	        <td><span class="label">{translate}Assigment created{/translate}</span></td>
	        <td>
	           <input name="created_{$datePart_0}" id="created_{$datePart_0}" type="text" style="width: 21px;" value="{$createdDate.0}"><span class="label">-</span><input name="created_{$datePart_1}" id="created_{$datePart_1}" type="text" value="{$createdDate.1}" style="width: 21px;"><span class="label">-</span><input name="created_{$datePart_2}" id="created_{$datePart_2}" type="text" value="{$createdDate.2}" style="width: 40px;"><span class="label">&nbsp;&nbsp;</span><input name="createdTime" id="createdTime" type="text" value="{$createdTime}" style="width: 40px;"/>
	           <br/>
	           <span class="label" style="width: 21px; color: #AAA;">({$datePart_0}-{$datePart_1}-{$datePart_2} hh:mm)</span>
	        </td>
	    </tr>
	    <tr valign="top">
	        <td><span class="label">{translate}Diagnosis{/translate}</span></td>
	        <td colspan="2">
	            <textarea rows="2" cols="40" name="diagnosis" id="diagnosis">{$radTicket->getDiagnosis()}</textarea>
	        </td>
	    </tr>
	</table>
<div>